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Transition Legislative Oversight Committee made these five SCHIP recommendations in areport to the legislature in December 2004: 1) maintain six-month continuous eligibility, 2)maintain the assets test that took effect in 2004, 3) restore dental and vision benefits, 4)increase co-payments and link them directly to service benefits, and 5) require a singleenrollment fee instead of monthly premiums. 126 Other bills have been filed to help with SCHIPfunding, such as a cigarette tax with part of the proceeds going to restore SCHIP cuts. 127Several other measures were mandated by the 78th Texas Legislature to control Medicaid costsas well as enhance the effectiveness and quality of the program. These included the study andimplementation of a Preferred Drug List within the Medicaid Vendor Drug Program and DiseaseManagement guidelines for people with certain chronic diseases. 128Waivers and Other Expansion Initiatives in TexasCurrent SituationTexas currently has five 1915(b) waivers for Medicaid managed care and hospital contractingand seven 1915(c) waivers for home and community-based services. 129 Texas does not havean 1115 waiver. The state applied for an 1115 waiver in August 1995 after studying the optionsfor controlling the state’s rapidly escalating Medicaid costs. This waiver would have expandedMedicaid coverage, eligibility, and managed care. The waiver was not approved by the U.S.Health and Human Services Department for a variety of reasons, and a subsequent smaller1115 waiver submitted in October 1996 addressing children’s health care was later abandoneddue to the coming of SCHIP. 130Texas Senate Bill 1156 was passed in 2001 authorizing the Texas Health and Human ServicesCommission (HHSC) to pursue a variety of changes and improvements in Medicaid, but it wasvetoed by Governor Perry. Had it become law, it would have allowed HHSC to apply for an1115 waiver to expand access to family planning and preventive services for women up to 185percent FPL. Even though it would expand coverage, it was projected to save the state fundsdue to the enhanced 90 percent matching rate for family planning services and the fact that thispopulation is eligible for Medicaid when pregnant. 131 Work on a family planning waiver hadbeen done before this bill, and a similar bill was introduced in 2003 but did not make it out ofcommittee. A women’s health and family planning waiver is currently being considered in the79th Texas Legislature (2005).New Waivers Submitted or under ConsiderationThe state has a number of expansion initiatives currently under consideration. HHSC submittedan 1115 HIFA waiver to CMS for a SCHIP premium assistance program in December 2004, andif approved, the program would begin on October 1, 2005. 132 This SCHIP buy-in program,authorized by House Bill 3038 of the 77th Texas Legislature and Senate Bill 240 of the 78thLegislature, would allow state and federal SCHIP funds to be used to pay part of the premiumsto enroll eligible individuals into private health insurance plans. (Texas already has a premiumassistance program in place for Medicaid, called HIPP, or the Health Insurance PremiumPayment program. 133 )The HIFA waiver would create a premium assistance option for SCHIP-eligible children andfamily members, if cost-effective. A flat subsidy amount would be available to all eligiblechildren and families up to 200 percent FPL. The subsidy amount would be set at 5 percentless than the average cost per child, minus a per-child administrative cost; this is how theprogram will achieve budget neutrality. 134 The premium assistance option is expected to coverabout 9,504 people. 135 Because this expansion could actually require higher cost-sharing forB-29